{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Iva E Godin","gend":1,"currentgend":"","add":"62 WALTON MILLS RD","city":"CORNVILLE","state":"ME","zip":"04976","dob":"1940-07-13","age":"","mstatus":"","insh":"10000076663","cliId":"","pno":2074748211,"cno":"","email":"declined@041425.com","ename":"","eno":"","pphy":"WEBB, TIMOTHY S","ppno":2078726869,"pcpadd":"Elmwood Primary Care,221 Main St","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"ELMWOOD PRIMARY CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"62 WALTON MILLS RD","madd2":"","madd3":"","mcity":"CORNVILLE","mstate":"ME","mzip":"04976","pcpfaxno":2078727910,"pcpnpi":1376602276,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8YE1DE5JH28","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11610","E1142","F0390","R531","H353131","H43813","E113293","Z0101","E1122","Z1231","L309","H401131","R2681","M19012","R21","M14679","R4701","H40053","H35342","R300","H527","R413","B351","M14672","R262","H5201","H5203","H52223","E785","E119","S199XXA","S0990XA","E1169","S4992XD","G319","R9089","I10","K5900","R4181","R519","L602","F32A","G4700","S90422A","Z9181","Z022","S50312A","L84","L853","R45851","S3991XA","S3993XA","S299XXA","Z0000","B078","R059","Z0001","H409","I129","N1830","F03A0","H9190","Z79899"],"date":["2024-12-12","2025-01-31","2025-10-29","2025-10-15","2024-09-27","2023-09-25","2024-09-27","2023-09-25","2024-03-07","2023-06-13","2025-09-16","2023-03-23","2025-10-15","2025-10-15","2025-09-09","2025-01-21","2025-09-22","2023-03-23","2023-03-23","2025-09-03","2023-03-23","2025-04-29","2025-05-13","2024-12-30","2024-02-27","2023-09-25","2024-09-27","2024-09-27","2023-03-17","2025-03-19","2025-08-27","2025-08-27","2023-02-10","2025-09-04","2024-06-06","2024-06-06","2025-09-30","2023-03-24","2023-03-24","2023-03-24","2023-06-29","2023-06-29","2025-06-23","2025-08-30","2025-08-30","2025-08-30","2025-08-30","2023-02-10","2025-04-18","2025-04-18","2025-08-27","2025-08-27","2025-08-27","2025-07-10","2023-01-05","2023-01-05","2023-10-16","2023-10-16","2024-03-07","2024-03-07","2024-04-29","2024-04-29","2024-04-29"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","METFORMIN HCL","","","Select","Select",""],["","","TRUE METRIX GLUCOSE TEST STRIP","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","DENTA 5000 PLUS","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","DORZOLAMIDE-TIMOLOL","","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[],"comment":[],"sub":[]}}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}